(CSEMP066) PREVALENCE AND CHARACTERISTICS OF ADRENAL INCIDENTALOMAS IN PATIENTS WITH LUNG TRANSPLANTS : A RETROSPECTIVE COHORT STUDY

Abstract:

Background: Adrenal incidentalomas are adrenal lesions found on imaging performed for reasons other than suspected adrenal disease. The prevalence of adrenal incidentalomas is about 3% in patients. Hormone assessment is recommended in patients with adrenal incidentalomas by current guidelines. Recently, chronic hypoxemia exposure such as in cyanotic congenital heart disease and high altitude was found to be a risk factor for pheochromocytomas and paragangliomas. However there is no data available on adrenal incidentalomas in lung transplant patients.

Objectives: To evaluate the prevalence of adrenal incidentalomas in lung transplant patients, and to assess the proportion evaluated according to guidelines.

Design: In this retrospective single-center study, we reviewed the records of adult patients who underwent pulmonary transplant at our hospital center from 2014 to 2020. Data was collected using hospital database and the presence of adrenal incidentalomas was assessed using the most recent thoracic and abdominal CT-scans.

Results: Our study included 398 patients who underwent lung transplant. Our cohort consisted of 163 females (41%) and 235 males (59%). Mean age was of 53 yo (median: 58 yo). Before transplant, 94% of patients were hypoxemic, with a mean of 4.3 years and a median of 2 years of home oxygen-therapy. Thirteen cases of adrenal incidentalomas were identified (prevalence of 3.3%). Among the 13 patients, 9 were female (69%) and the mean age was of 52 yo (median: 58 yo). All of these patients were hypoxemic before transplant, with home oxygen-therapy for a mean time of 5 years and a median time of 2 years. Prior to transplant, 3 patients with incidentalomas were known for hypertension, 1 for diabetes and 3 for coronary artery disease. Two out of 13 patients (15%) had bilateral adrenal incidentalomas. The radiologic mean adrenal mass size was 15.7 mm (range from 11 to 34 mm) and Hounsfield Units (HU) ranged from -7 HU to 26 HU (N:5). No patient had hormonal work-up according to guidelines, and none were referred to an endocrinologist.

Conclusions: We found a prevalence of 3.3% of adrenal incidentalomas in our cohort of pulmonary transplant patients, which is similar to the general population. As in the majority of patients with adrenal incidentalomas, adrenal hormonal work-up is lacking in lung transplant patients. Hormonal investigations are currently being conducted to determine hormonal profiling of these adrenal masses and to determine the prevalence of pheocromocytomas in this cohort of hypoxemic lung transplant patients.